Provider Demographics
NPI:1679323984
Name:CLOVIS NM CAREGIVING LLC
Entity Type:Organization
Organization Name:CLOVIS NM CAREGIVING LLC
Other - Org Name:CORNERSTONE CAREGIVING
Other - Org Type:Other Name
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:COZBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-503-5233
Mailing Address - Street 1:2612 WASHINGTON AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-7469
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2300 N MAIN ST STE 21
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-3575
Practice Address - Country:US
Practice Address - Phone:575-366-9609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORNERSTONE CAREGIVING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-27
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care